中华内科杂志最新文献

{"title":"[Interpretation of minimal residual disease for response evaluation in guidelines for the diagnosis and management of multiple myeloma in China (2024 revision)].","authors":"Y J Chang, C C Fu","doi":"10.3760/cma.j.cn112138-20240929-00618","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240929-00618","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"63 12","pages":"1179-1182"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Association between plasma-glycosylated hemoglobin A_1c/high-density lipoprotein cholesterol ratio and urinary albumin-creatinine ratio in Chinese adults].","authors":"W J Dong, P Pang, L Y Song, D Sun, S J Yan, G Q Yang, Y M Mu, W J Gu","doi":"10.3760/cma.j.cn112138-20240822-00528","DOIUrl":"10.3760/cma.j.cn112138-20240822-00528","url":null,"abstract":"<p><p><b>Objective:</b> To explore the relationship between glycosylated hemoglobin A_1c/high-density lipoprotein cholesterol ratio (HbA_1c/HDL-C) and urinary albumin-creatinine ratio (UACR) in Chinese adults. <b>Methods:</b> In this cross-sectional study, the clinical data of 43 820 community residents (age>40 years) from the Risk Evaluation of Cancers in Chinese Diabetic Individuals (REACTION study; March-December 2012) across eight centers (Liaoning, Guangdong, Shanghai, Gansu, Guangxi, Henan, Hubei, and Sichuan) in China were collected and analyzed. Participants were divided into three groups based on UACR levels:<10 mg/g, 10-30 mg/g, and >30 mg/g. The HbA_1c/HDL-C ratio was divided into four groups according to quartile division of the subjects: 1st quartile (Q1<3.79), 2nd quartile (3.79≤Q2<4.59), 3rd quartile (4.59≤Q3≤5.66), and 4th quartile (Q4>5.66). Multivariate ordinal logistic regression model was used to analyze the relationship between HbA_1c/HDL-C and UACR. Receiver operating characteristic (ROC) analysis was used to explore the predictive value of HbA_1c/HDL-C to UACR. <b>Results:</b> The 43 820 subjects included 13 452 (30.70%) male and 30 378 (69.30%) female patients, with an average age of (58.00±0.05) years. According to results of one-way analysis of variance analysis, the HbA_1c/HDL-C ratio was significantly associated with the risk of increased UACR (<i>F</i>=495.73, <i>P</i><0.001). After adjusting for clinically relevant confounding variables in logistic regression model, compared with participants with the lowest HbA_1c/HDL-C ratio (Q1), women with the highest HbA_1c/HDL-C ratio (Q4) had a 1.483-fold (95%<i>CI</i> 1.376-1.598, <i>P</i><0.001) and men had a 1.161-fold (95%<i>CI</i> 1.019-1.323, <i>P</i><0.001) increased risk of UACR. The ROC curve analysis showed that the area under the curve of HbA_1c/HDL-C for predicting increased UACR was 0.623 (95%<i>CI</i> 0.597-0.606), with a sensitivity of 60.18% and a specificity of 54.91%. The HbA_1c/HDL-C ratio showed the highest predictive value of all glycemic and lipidemic parameters. In individuals with well-controlled blood glucose (HbA_1c<6.5%) or lipid levels (HDL-C≥1.0 mmol/L), the HbA_1c/HDL-C ratio was still independently associated with the risk of increased UACR after adjusting for confounding variables [<i>OR</i>(95%<i>CI</i>) of quartile 4: 1.563 (1.210-2.019, <i>P</i>=0.001) in participants with HbA_1c<6.5% and 1.822 (1.687-1.968, <i>P</i><0.001) in participants with HDL-C≥1.0 mmol/L]. <b>Conclusion:</b> As a novel compound indicator for evaluating glucose homeostasis and dyslipidemia, the HbA_1c/HDL-C ratio was independently associated with increased UACR in the general population aged>40 years in China, which was superior to both glycemic and lipid parameters alone.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"63 12","pages":"1228-1237"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Advances for treatment of relapsed or refractory multiple myeloma: interpretation of guidelines for the diagnosis and management of multiple myeloma in China (2024 revision)].","authors":"Z Cai, W M Chen","doi":"10.3760/cma.j.cn112138-20241008-00661","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20241008-00661","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"63 12","pages":"1183-1185"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Expert consensus on dynamic critical values of hemorrhagic diseases based on clinical practice (2024 version)].","authors":"","doi":"10.3760/cma.j.cn112138-20240909-00565","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240909-00565","url":null,"abstract":"<p><p>The condition of hemorrhagic diseases is frequently characterized by a dynamic process of rapid change, making the monitoring and management of these fluctuations essential to enhance clinical outcomes. However, to our knowledge, there is currently no established reference value for dynamic early warning standards. This consensus draws upon relevant literature and the practical experience of clinical experts to evaluate dynamic changes in patients with hemorrhagic diseases based on various perspectives such as laboratory tests, radiological imaging, and ultrasound examinations. It aims to formulate a consensus on dynamic critical values for hemorrhagic diseases grounded in clinical practice, thereby providing a framework for early warning in such patients.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"63 12","pages":"1205-1215"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Update on spondyloarthritis over the last two decades].","authors":"J X Zhang, F Huang","doi":"10.3760/cma.j.cn112138-20241009-00667","DOIUrl":"10.3760/cma.j.cn112138-20241009-00667","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"63 12","pages":"1149-1159"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Effect of an artificial intelligence-assisted recognition system on colonoscopy quality].","authors":"B Jin, L Huang, S Liu, B Lyu, Y Hu","doi":"10.3760/cma.j.cn112138-20240216-00109","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240216-00109","url":null,"abstract":"<p><p><b>Objective:</b> To explore the value of the artificial intelligence (AI)-assisted recognition system in the detection quality of colonoscopy. <b>Methods:</b> From January 2023, the data on 700 patients who underwent colonoscopy in the Digestive Endoscopy Center of the First Affiliated Hospital of Zhejiang Chinese Medical University were collected prospectively. Based on a computerized number method, patients were divided into the AI assistance group and control group. The detection rate of adenomas (ADR) and polyps, number and size of adenomas, Boston bowel preparation scale (BBPS), intubation time, withdrawal time, and cecal intubation rate were compared between groups. Normally distributed data were analyzed with the <i>t</i>-test for independent samples. Non-normally distributed data were analyzed with the Rank sum test. Categorical data were analyzed with the Chi-square test. <b>Results:</b> In total, 691 patients were included in the analysis. According to the intention to treat (ITT) analysis and per-protocol (PP) analysis, the withdrawal time of the AI group was higher than that of the control group (ITT:436 (305, 620) vs 368 (265, 510) s, <i>Z</i>=-4.24, <i>P</i><0.001;PP:439 (306, 618) vs 364 (262, 500) s,<i>t</i>=-4.50, <i>P</i><0.001); however, there were no significant differences in the ADR (ITT:123(35.5%) vs 111(32.2%), <i>χ</i>²=0.88, <i>P</i>=0.349;PP:108(34.2%) vs 99(31.1%), <i>χ</i>²=0.67, <i>P</i>=0.414), the number of adenomas (ITT:0(0, 1) vs 0(0, 1),<i>Z</i>=-1.08, <i>P</i>=0.282;PP:0(0, 1) vs 0(0, 1),<i>Z</i>=-0.87, <i>P</i>=0.387), the polyp detection rate (ITT:85(24.6%) vs 85(24.6%),<i>χ</i>²=0.001, <i>P</i>=0.983;PP:79(25.0%) vs 77(24.2%),<i>χ</i>²=0.05, <i>P</i>=0.818), BBPS (ITT:6.5±0.9 vs 6.5±0.7,<i>t</i>=-0.59, <i>P</i>=0.555;PP:6.7±0.6 vs 6.6±0.6,<i>t</i>=-1.83, P=0.068), and cecal intubation rate (ITT:346(100.0%) vs 343(99.4%), <i>χ</i>²=0.50, <i>P</i>=0.478) between these two groups. After excluding inadequate bowel preparation and failed cecal intubation cases, the AI-assisted system was found to significantly improve the detection rate of small adenomas (≤5 mm) (PP:27.8%(88/316)vs 21.1%(67/318), <i>χ</i>²=3.94, <i>P</i>=0.047). <b>Conclusions:</b> The application of an AI-assisted system in colonoscopy can increase the withdrawal time and improve the detection rate of small adenomas.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"63 11","pages":"1111-1115"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Expert consensus on the perioperative management of co-ablation system therapy of lung tumors].","authors":"","doi":"10.3760/cma.j.cn112138-20240620-00394","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240620-00394","url":null,"abstract":"<p><p>In order to improve the quality of clinical therapy and nursing care for patients with lung tumors undergoing Co-Ablation System and standardize perioperative management, the Committee of Ablation Therapy in oncology, Chinese Anti-Cancer Association, and the Expert committee on Ablation Therapy and the Committee of Interventional Perioperative, Interventional Physician Branch of Chinese Medical Doctor Association organized medical and nursing experts in China. Based on the clinical practice of Co-Ablation System therapy in China and relevant domestic literature, a perioperative management expert consensus was developed. The expert consensus included the key points of perioperative nursing care, prevention and intervention of complications, and discharge guidance for Co-Ablation System therapy of lung tumors, to provide reference for the standardization and development of clinical management for lung tumors.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"63 11","pages":"1078-1086"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[2024 Chinese guidelines for the diagnosis and treatment of rheumatoid arthritis].","authors":"","doi":"10.3760/cma.j.cn112138-20240531-00360","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240531-00360","url":null,"abstract":"<p><p>Rheumatoid arthritis(RA) is an autoimmune disease characterized by erosive arthritis, which is an important cause of disability in Chinese population. It is of great significance to formulate and update RA diagnosis and treatment guidelines that meet the standards of international guidelines and clinical practice in China. The update of the Chinese guidelines for the diagnosis and treatment of RA was initiated by National Clinical Research Center for Dermatologic and Immunologic Diseases, jointly with the Chinese Association of Rheumatology and Immunology Physicians, the Rheumatology and Immunology Professional Committee of Chinese Rehabilitation Medical Association, the Rheumatology and Immunology Professional Committee of Chinese Research Hospital Association, and the Rheumatology and Immunology Branch of Beijing Association of Holistic Integrative Medicine. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist were followed to update the guidelines. The guidelines provide evidence-based recommendations on 10 clinical issues which were concerned by Chinese rheumatologists. The aim is to improve the level of diagnosis and standard treatment of RA in China, and to improve the quality of life and prognosis of patients.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"63 11","pages":"1059-1077"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Correlation of Impulse oscillometry system indices with conventional pulmonary function tests in patients with obstructive pulmonary ventilation dysfunction].","authors":"B Wei, K Zhang, Z Y Wang, B H Fu, X M Huang, Y T Chen, J P Zhao, J M Wang, M Xie, W Ni","doi":"10.3760/cma.j.cn112138-20240410-00231","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240410-00231","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the correlation between impulse oscillometry system examination indicators and conventional pulmonary ventilation function. &lt;b&gt;Methods:&lt;/b&gt; The pulmonary ventilation function data of 10 883 patients from January 1, 2020 to December 31, 2022 at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were included. The one-second rate [ratio of forced expiratory volume in the first second (FEV&lt;sub&gt;1&lt;/sub&gt;) to forced vital capacity (FVC)] measured as a percentage of the predicted value was ≥92% for the control group (&lt;i&gt;n=&lt;/i&gt;3 478) and &lt;92% for the pulmonary obstruction group (&lt;i&gt;n=&lt;/i&gt;7 405). The obstruction group was subdivided into five groups according to the degree of pulmonary dysfunction: mild group (&lt;i&gt;n=&lt;/i&gt;3 938),moderate group (&lt;i&gt;n=&lt;/i&gt;1 142),oderate-severe group (&lt;i&gt;n=&lt;/i&gt;917),severe group (&lt;i&gt;n=&lt;/i&gt;737),and extremely severe group (&lt;i&gt;n=&lt;/i&gt;671). Conventional pulmonary ventilatory function FVC, FEV&lt;sub&gt;1&lt;/sub&gt;, one-second rate, and forced expired flow at 50% of FVC (MEF50%), forced expired flow at 75% FVC (MEF25%), maximal mid-expiratory flow (MMEF), peak expiratory flow (PEF), and pulsed oscillation pulmonary function test were detected in both groups of patients. Impedance at 5 Hz (Z5) means total respiratory resistance, resistance at 5 Hz (R5) means total airway resistance, reactance at 5 Hz (X5) indicates the elastic recoil of the peripheral airways, and resistance at 20 Hz (R20) represents resistance of the central airways. R5-R20 reflects resistance in the small airways. Additionally, peripheral resistance (Rp), respiratory resonance frequency (Frex), and area under the reactance curve (Ax) were also measured. Correlation between the indicators of the two groups and the sensitivity and specificity of the impulse oscillometry system parameters for the diagnosis of obstructive pulmonary ventilation dysfunction were analyzed. &lt;b&gt;Results:&lt;/b&gt; Pulmonary function force expiratory volume in the first second as a percentage of predicted value (FEV&lt;sub&gt;1&lt;/sub&gt;%Pre) [80.10 (54.95,97.10)%],one-second rate [62.43(48.67, 67.02)%],MEF50% [1.33 (0.62,1.97)L/s],MEF25% [0.28 (0.17,0.41)L/s], MMEF [0.85 (0.43,1.29)L/s],and PEF [5.64 (3.73,7.50)]L/s in the obstruction group were significantly lower than those in the control group (&lt;i&gt;P&lt;&lt;/i&gt;0.05). The differences within the subgroups of the obstruction group were also significant (&lt;i&gt;P&lt;&lt;/i&gt;0.05). Pulsed oscillation Z5 [0.42 (0.33,0.55)kPa·L&lt;sup&gt;-1&lt;/sup&gt;·s&lt;sup&gt;-1&lt;/sup&gt;],Rp [0.25 (0.20,0.45)kPa·L&lt;sup&gt;-1&lt;/sup&gt;·s&lt;sup&gt;-1&lt;/sup&gt;], R5 [0.39 (0.31,0.49)kPa·L&lt;sup&gt;-1&lt;/sup&gt;·s&lt;sup&gt;-1&lt;/sup&gt;], R20 [0.28 (0.24,0.34)kPa·L&lt;sup&gt;-1&lt;/sup&gt;·s&lt;sup&gt;-1&lt;/sup&gt;], R5-R20 [0.09 (0.05,0.17)kPa·L&lt;sup&gt;-1&lt;/sup&gt;·s&lt;sup&gt;-1&lt;/sup&gt;],Frex [16.32 (13.07,20.84)Hz], and Ax [0.67 (0.28,1.64)] indices in the obstruction group were significantly higher than those in the control group. X5 [-0.14 (-0.23, -0.10)kPa·L&lt;sup&gt;-1&lt;/sup&gt;·s&lt;sup&gt;-1&lt;/sup&gt;] was significantly lower than that i","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"63 11","pages":"1087-1095"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Reflections on critical care ultrasound training: clinical analysis, protocol, view, approach and practice-workflow (CPVAP) modular training and base training model].","authors":"X Y Zeng, W He, Y Qin, X T Wang, Y G Chao, Y Kang, M G Yin","doi":"10.3760/cma.j.cn112138-20240613-00382","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240613-00382","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"63 11","pages":"1052-1058"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}